Provider Demographics
NPI:1083099600
Name:SKYLIGHT DENTAL CARE PLLC
Entity Type:Organization
Organization Name:SKYLIGHT DENTAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LICETTE
Authorized Official - Middle Name:F
Authorized Official - Last Name:ESPINAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:813-530-0991
Mailing Address - Street 1:117 N. OAKWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510
Mailing Address - Country:US
Mailing Address - Phone:813-530-0991
Mailing Address - Fax:813-530-0986
Practice Address - Street 1:117 N. OAKWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510
Practice Address - Country:US
Practice Address - Phone:813-530-0991
Practice Address - Fax:813-530-0986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19212261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003256800Medicaid